Human Immunodeficiency Virus Positive Mothers Research Articles

English

Mother-to-child transmission is the largest source of human immunodeficiency virus (HIV) infection in children. About one third of children are believed to be infected vertically through breast-feeding. Infant feeding in the context of HIV is complex. HIV positive women are confused about feeding methods and mixed feeding continued to be widespread. However, there are few studies on the practice of HIV positive mothers and counseling message of health workers in Ethiopia (Maru and Haidar, 2009). Objective: The objective of this study was to assess magnitude and factors associated with infant and young child feeding practice of HIV positive mothers in selected hospitals of Southern Nations Nationalities and Peoples of Region, 2011. An institution based cross sectional study was conducted using both quantitative and qualitative methods. A total of 201 HIV positive mothers with children less than two years of age were purposively selected at morning time in order of arrival. Health workers working on anti -retroviral therapy and prevention of mother to child transmission clinics were taken for in-depth interview in Hawassa, Yirgalem and Dilla Hospitals. Of all respondent, 87 (47.5%) HIV positive mothers had children with the age of less than 6 months, among 87 (47.5%) HIV positive mothers, 56.3% had experience of exclusive breast feeding, 13 (35.6%) of the mothers mix fed their babies while 8.1% exclusive replacement feeding. Regarding issues discussed during counseling time by health workers, from total of 183 HIV positive mothers, 78.7% mothers received counseling on different feeding options. Most, 96.2 and 76.0% of mothers received counseling on advantages and disadvantages of breast feeding respectively, and 67.8 and 71% disadvantages of replacement and mixed feeding respectively. Mother‘s who had antenatal follow up and favorable attitude towards feeding options were more likely to practice exclusive breast feeding and less likely to practice mixed feeding. More than half of the mothers practiced exclusive breast feeding and very small proportion of HIV positive mothers chose replacement feeding, but still greater than one third of HIV positive mothers practiced mixed feeding. In general, infant and young child feeding practices observed in this study fall short of the World Health Organization (WHO) recommendations, so it is recommended that all HIV positive mothers should be provided with adequate information to enable them to select the best feeding option for their babies, and to successfully carry out their infant feeding decisions. Key words: Infant and young child, feeding practice, HIV.

FCGR2A and FCGR3A Genotypes in Human Immunodeficiency Virus Mother-to-Child Transmission.

Background. Fc-mediated effector functions have been suggested to influence human immunodeficiency virus (HIV) acquisition and disease progression. Analyzing the role of host Fc gamma receptor (FcγR) polymorphisms on HIV outcome in mother-to-child transmission (MTCT) will increase our understanding of how host genetics may alter immune responses in prevention, therapy, and disease. This study analyzed the impact of FCGR2A and FCGR3A genotypes on MTCT in a cohort in which Fc-mediated antibody functions are predictive of infant HIV outcome. Methods. Human immunodeficiency virus-positive mothers and their infants from a historical MTCT cohort were genotyped for FCGR2A and FCGR3A. We assessed the impact of these genotypes on transmission and acquisition of HIV and disease progression using χ(2) tests, survival analyses, and logistic regression. Results. Among 379 mother-infant pairs, infant FCGR2A and FCGR3A genotypes were not associated with infant HIV infection or disease progression. Maternal FCGR2A was not associated with transmission, but there was a trend between maternal FCGR3A genotype and transmission (P = .07). When dichotomizing mothers into FCGR3A homozygotes and heterozygotes, heterozygotes had a 64.5% higher risk of transmission compared with homozygotes (P = .02). This risk was most evident in the early breastfeeding window, but a trend was only observed when restricting analyses to breastfeeding mothers (hazards ratio, 1.64; P = .064). Conclusions. Infant FCGR2A and FCGR3A genotypes were not associated with HIV infection or disease progression, and, thus, host FcγR genotype may not significantly impact vaccination or therapeutic regimens that depend on Fc-mediated antibody functions. Maternal FCGR3A genotype may influence early breastfeeding transmission risk, but more studies should be conducted to clarify this association and its mechanism.

Evaluation of DAVIH -AgP24 ELISA system for early diagnosis of infant Human immunodeficiency virus type 1 infection in Cuba.

Evaluation of DAVIH -AgP24 ELISA system for early diagnosis of infant Human immunodeficiency virus type 1 infection in Cuba.

A Simple Regression-based Approach to Account for Survival Bias in Birth Outcomes Research.

In perinatal epidemiology, birth outcomes such as small for gestational age (SGA) may not be observed for a pregnancy ending with a stillbirth. It is then said that SGA is truncated by stillbirth, which may give rise to survival bias when evaluating the effects on SGA of an exposure known also to influence the risk of a stillbirth. In this article, we consider the causal effects of maternal infection with human immunodeficiency virus (HIV) on the risk of SGA, in a sample of pregnant women in Botswana. We hypothesize that previously estimated effects of HIV on SGA may be understated because they fail to appropriately account for the over-representation of live births among HIV negative mothers, relative to HIV positive mothers. A simple yet novel regression-based approach is proposed to adjust effect estimates for survival bias for an outcome that is either continuous or binary. Under certain straightforward assumptions, the approach produces an estimate that may be interpreted as the survivor average causal effect of maternal HIV, which is, the average effect of maternal HIV on SGA among births that would be live irrespective of maternal HIV status. The approach is particularly appealing, because it recovers an exposure effect which is robust to survival bias, even if the association between the risk of SGA and that of a stillbirth cannot be completely explained by adjusting for observed shared risk factors. The approach also gives a formal statistical test of the null hypothesis of no survival bias in the regression framework.

Predictors of Breastfeeding Cessation among HIV Infected Mothers in Southern Ethiopia: A Survival Analysis

BackgroundMother-to-child transmission (MTCT) of Human immunodeficiency virus (HIV) through breastfeeding remains the most significant route infection among children. Although the current guideline is recommending continued breastfeeding for HIV exposed infants, significant proportion of infants have been subjected to early weaning to prevent HIV transmission. However the predictors of breastfeeding cessation among HIV positive mothers were not documented in Ethiopia. Therefore the objective of this study was to determine the predictors of breastfeeding cessation among HIV-infected women in Southern Ethiopia.MethodsA facility based cross sectional study was conducted in Southern Ethiopia. The samples were selected by cluster sampling technique. The Kaplan-Meier curve was used to describe the survival time of breastfeeding and a step-wise multivariable Cox-proportional hazards regression model were used to identify the predictors of breastfeeding cessation. Both crude and adjusted hazard ratio were determined and p<0.05 was considered as statistically significant.ResultThe mean duration of breastfeeding among HIV positive mothers was 13.79 [95% CI: (12.97–14.59)] months. The Kaplan-Meier estimate showed that proportions of women who were breastfeeding at 6, 9, 12 and 17 months were 89.3%, 75.3%, 66% and 17%, respectively. Those mothers having a monthly income of ≤500 ETB [AHR = 0.16, 95% CI :(0.03–0.76)], having a family size of three and below [AHR = 0.12, 95%CI: (0.02–0.68), four and above [AHR = 0.07, 95%CI: (0.01–0.35)] and bottle feeding [AHR = 3.95, 95%CI: (1.64–9.51)] were also independent factors associated with breastfeeding cessation.ConclusionAbove one third of HIV positive mothers stopped breastfeeding before 12 months. Monthly income, bottle feeding and family size were the independent predictors of breastfeeding cessations. Strengthening the current counseling and promotion modality on avoidance of bottle feeding and continued breastfeeding is recommended for improved HIV free survival.

Virtual Elimination of Mother-to-Child Transmission of Human Immunodeficiency Virus in Mothers on Highly Active Antiretroviral Therapy in Enugu, South-Eastern Nigeria.

Background:With the current World Health Organization (WHO) “Option B+” for prevention of mother to child transmission (PMTCT) of human immunodeficiency virus (HIV), virtual elimination of mother to child transmission (eMTCT) is highly achievable.Aim:The aim of this study is to determine the rate of MTCT of HIV from mothers who started highly active antiretroviral therapy (HAART) for life from diagnosis during pregnancy to the exposed babies who had daily nevirapine in the first 6 weeks of life.Subjects and Methods:HIV positive mothers and their exposed babies who enrolled for the hospital PMTCT protocol from January 1, 2009 to December 31, 2011 were studied. The babies were tested for HIV using deoxyribo nucleic acid polymerase chain reaction test at 6 weeks, and then HIV rapid tests at 18 months.Results:A total of 5,946 booked mothers had HIV testing and counseling (HTC) within the study period. Two hundred and twenty-three (223/5946, 3.7%) were positive, out of which 188 (188/223, 84.3%) enrolled for the PMTCT interventions while 35 (35/223, 15.7%) did not enroll. Three of the enrollees were lost to follow up and two were referred to another PMCT center. Of the remaining 183 enrolled HIV positive mothers, one gave birth to a set of twins, giving a total of 184 exposed babies. There were two cases of intrauterine fetal death of unknown fetal HIV status. None of the 182 remaining babies evaluated for HIV testing tested positive to HIV.Conclusions:With adequate suppression of maternal viral replication with HAART using the WHO Option B+, eMTCT of HIV is achievable in a developing country like Nigeria where infant breastfeeding is a norm.

PCR Results and PMTCT Treatment Outcomes among HIV-Exposed Infants in a Tertiary Hospital in Nigeria, 2010-2014

Early infant diagnosis (EID) of human immunodeficiency virus (HIV) infection in pediatrics with the use of DNA polymerase chain reaction (PCR) is a way of assessing the retroviral status of HIV-exposed infant with the view of early commencement of treatment for infected infants. It also serves as a way of assessing the effectiveness of prevention of mother-to-child transmission of HIV (PMTCT) in health care facilities. This was a 5-year prospective cross-sectional study at the Ekiti State University Teaching Hospital, (EkSUTH) Ado-Ekiti, Nigeria. Babies delivered to HIV-positive mothers who presented at EkSUTH between January 2010 and December 2014 were enrolled in the present study. PCR was done twice for all HIV-exposed infants. Statistical analysis was done using SPSS version 16.0. One hundred and fifty eight infants were HIV exposed; 72 males and 86 females (M:F= 0.84:1). Eighty eight (55.7%) of the mothers had commenced highly active anti-retroviral therapy (HAART) before pregnancy, 56 (35.4%) during pregnancy, and 14 (8.9%) after delivery. Ten (6.3%) babies tested positive. Four (28.6%) of 14 exposed babies whose mothers commenced HAART after delivery tested positive to HIV compared to 3 (5.4%) of 56 babies whose mother commenced HAART during pregnancy and 3 (3.4%) of 88 babies whose mother commenced HAART before pregnancy. The difference was statistically significant (c(2) = 13.28, df = 4, p = 0.01). There is significant reduction in transmission of HIV from mothers to children with commencement of antiretroviral drugs before pregnancy in mothers and use of Nevirapine for all exposed babies for the first 6 weeks of life. Infants of HIV positive mothers can live healthy life free of HIV infection if their mothers participate in PMTCT program.

Birth Outcomes in HIV-1-Infected Women Receiving Highly Active Antiretroviral Therapy (HAART) Prior to Conception versus During Pregnancy in Yaoundé, Cameroon

Objective: To assess the impact of antiretroviral on birth outcome according to the timing of antiretroviral initiation in relation to pregnancy in human immunodeficiency virus (HIV) infected pregnant women. Methods: Cross sectional study, observational, in a single referral site, the Centre Hospitalier d’ESSOS of Yaounde from 2008 to 2013. Babies born to HIV positive mothers under HAART prior to conception were compared with those initiating treatment during pregnancy. Main measurement: rate of preterm birth (PTB) defined as gestational age<37 weeks at birth and low birth weight (LBW)<2500 g. Results: We included 617 newborn babies. Almost 96% of their mothers were taking antiretroviral drugs free of protease inhibitor. Overall rate of LBW was at 11.6% and PTB at 9.7 %. In bivariate analysis, PTB were similarly rated in preconception HAART(8.1%) versus during pregnancy (10.1%), odd ratio (1.22: 0.6-2.5, p=0.90); in ART started during pregnancy, the PTB frequency was analogous, irrespective of the moment of antiretroviral therapy (ART) started before 28 weeks (10.9%), or after (9%), p=0.9. In addition, LBW rates were registered at 11.7% prior to pregnancy versus 11.6% after conception (p=0.9). The ART started during pregnancy <28 weeks pregnancy was almost twice associated to a higher risk of LBW odd ratio (1.87: 1.02-3.44, p<0.05). Conclusion: ART prior to conception mainly free of protease inhibitor does not increase the risk of PTB or LBW in Yaounde, Cameroon.

Prevención de la transmisión materno-infantil del virus de inmunodeficiencia humana de tipo 1 en Uruguay: 1987-2009. Análisis de las diferentes medidas adoptadas

The prevention of vertical transmission (VT) of human immunodeficiency virus (HIV) is a priority as it generally is an avoidable disease. To describe Uruguay's experience of VT during 23 years and the preventive measures adopted. Children of HIV positive mothers born between January 1987 and December 2009 were followed. The mother, pregnancy and children dependent variables were analysed. Infants were classified as infected, not infected, exposed but still in evaluation, or withdrawn of the protocol. The different measures implemented were analyzed. There were 1353 children of HIV positive mothers; 204 (15.1%) infants were infected. The percentage of VT diminished throughout the years; between 2003 and 2009 it decreased to 6%. Protective factors against HIV VT were antiretroviral therapy (ARV) during pregnancy, elective caesarean section and not to nurse the newborn infant. Women who did not receive AlRV had a percentage of VT of 50.3 %. The VT has diminished in Uruguay. Special efforts must be done to screen all pregnant women, to improve diagnosis during pregnancy and to implement suitable ARV as occurs in developed countries.

Assessment of factors influencing adherence to anti-retroviral therapy for human immunodeficiency virus positive mothers and their infected children

Mothers and children are biologically related and dependent. They should be considered as a single unit which is very important regarding adherence to anti-retroviral therapy (ART). Very high levels of adherence are required for effective ART. We therefore carried out this study to examine the adherence levels and different factors associated with adherence among human immunodeficiency virus (HIV)-positive mothers and their HIV-positive children receiving ART. A hospital-based cross-sectional study. Ninety-four HIV-positive mothers and their 94 HIV-positive children under ART attending the ART center of a tertiary care hospital were recruited in this study. Consenting mothers were asked to complete the "Case Study Form" containing socio-demographic and care-giving details. Mothers were also asked to complete the Beck's depression inventory, State trait anxiety inventory, and Ways of coping inventory. Adherence was assessed using pill count. Criteria for good and poor adherence were defined. Current CD4 counts were retrieved from the hospital record. Fifty-six percent of respondent mothers and 65.8% of respondent children showed good adherence to ART. Different factors were associated with poor adherence in both mothers and their children. Adherence of HIV-positive mothers and their HIV-positive children to ART is influenced by multiple factors and identification of these factors is necessary to get complete adherence to ART. There is statistically significant relationship between maternal and pediatric adherence to ART.

High Human Immunodeficiency Virus-free Survival of Infants Born to Human Immunodeficiency Virus-positive Mothers in an Integrated Program to Decrease Child Mortality in Rural Rwanda

We retrospectively examined infant mortality and human immunodeficiency virus (HIV)-free survival among 211 infants who received a comprehensive package of health services, including breast milk substitution and clean water access, to prevent maternal-to-child transmission of HIV and improve child survival. The cumulative 12-month infant survival probability was 0.97 (95% confidence interval: 0.94-0.99). The cumulative 12- to 18-month HIV-free survival probability was 0.95 (confidence interval: 0.91-0.97).

Effect of using HIV and infant feeding counselling cards on the quality of counselling provided to HIV positive mothers: a cluster randomized controlled trial

BackgroundCounselling human immunodeficiency virus (HIV) positive mothers on safer infant and young child feeding (IYCF) options is an important component of programmes to prevent mother to child transmission of HIV, but the quality of counselling is often inadequate. The aim of this study was to determine the effect the World Health Organization HIV and infant feeding cards on the quality of counselling provided to HIV positive mothers by health workers about safer infant feeding options.MethodThis was a un-blinded cluster-randomized controlled field trial in which 36 primary health facilities in Kafue and Lusaka districts in Zambia were randomized to intervention (IYCF counselling with counselling cards) or non- intervention arm (IYCF counselling without counselling cards). Counselling sessions with 10 HIV positive women attending each facility were observed and exit interviews were conducted by research assistants.ResultsTotals of 180 women in the intervention group and 180 women in the control group were attended to by health care providers and interviewed upon exiting the health facility. The health care providers in the intervention facilities more often discussed the advantages of disclosing their HIV status to a household member (RR = 1.46, 95% CI [1.11, 1.92]); used visual aids in explaining the risk of HIV transmission through breast milk (RR = 4.65, 95% CI [2.28, 9.46]); and discussed the advantages and disadvantages of infant feeding options for HIV positive mothers (all p values < 0.05). The differences also included exploration of the home situation (p < 0.05); involving the partner in the process of choosing a feeding option (RR = 1.38, 95% CI [1.09, 1.75]); and exploring how the mother will manage to feed the baby when she is at work (RR = 2.82, 95% CI [1.70, 4.67]). The clients in the intervention group felt that the provider was more caring and understanding (RR = 1.81, 95% CI [1.19, 2.75]).ConclusionThe addition of counselling cards to the IYCF counselling session for HIV positive mothers were a valuable aid to counselling and significantly improved the quality of the counselling session.

Risk Factors for Prematurity among Neonates from HIV Positive Mothers in Cameroon

Objective: Human immunodeficiency virus (HIV) infection is the most important chronic health condition among women in childbearing age in sub-Saharan Africa. There is sparse data about socio-economic factors in the context with adverse outcome in pregnancy. The objective of the study was to identify such factors for prematurity, low birth weight (LBW) and intrauterine growth retardation (IUGR) in infants born to HIV-positive women in Cameroon. Methods: The study was done in Yaoundé between December 2001 and November 2007. Neonates born to HIV-positive mothers were monitored and clinical data as well as socio-economic factors were tested for association with prematurity, LBW and IUGR. Findings: In total, 264 neonates were analyzed. More prematurity occurred when mothers attended less than 4 prenatal care visits (OR [95% CI]: 2.7 [1.21-6.05]; p=0.015). HIV-classification >1 resulted in more IUGR (OR [95% CI]): 3.15 [1.4-7.4]; p=0.01) and LBW (2.20 [1.1-4.6]; p=0.03). Single women were more likely to attend 4 prenatal care visits or more (OR [CI95%]: 2.4 [1.6-3.4]; p<0.001); higher education resulted in better compliance with anaemia prophylaxis (OR [CI95%]: 3.0 [1.5-5.8]; p=0.002) and antimalaria prophylaxis (OR [CI95%]: 2.1 [1.4-3.3]; p<0.001); and was associated with early HIV diagnosis (p=0.003). Conclusion: Prenatal care improves outcome in pregnancy of HIV-positive women. Single mothers compared to women in family settings are more likely to attend prenatal care visits, and HIV was diagnosed earlier in pregnancy in this population. More effort should be put to address women in family settings to early diagnose HIV and to increase compliance with prenatal care.

Male participation and prevention of human immunodeficiency virus (HIV) mother-to-child transmission in Africa

The purpose of this review is twofold. First, it aims to summarize how the topic of male participation in HIV programs has been studied from a methodological point of view. The context is particularly in prevention of HIV transmission from mother to child (Prevention of Mother-to-Child Transmission, PMTCT). Second, it aims to describe how male participation has been described in the studies which have researched pregnant women's utilization of PMTCT programs, willingness and acceptance of testing for HIV and disclosure of HIV status to the male partner. This narrative review includes 31 studies (29 full texts and two abstracts) covering 15 different sub-Saharan African countries. The review showed that the approaches have been both qualitative and quantitative; varied study designs have been used in the varied settings. Male participation has been described to be both supportive and non-supportive. Supportive male participation such as a partner's willingness to be tested for HIV and spousal communication about reproductive matters has increased pregnant women's commitment to PMTCT programs. Non-supportive descriptions of male participation have included lack of discussion, HIV-related intimacy violence, and abandonment or fear of abandonment. Male participation has mostly been supportive of HIV positive mothers, but one challenge is how to prevent mother-to-child transmission in the case of non-supportive male participation. Another challenge is how to maintain the HIV negative status of pregnant women because few men have accepted testing. The development of the concept “male participation” in PMTCT of HIV programs might help to choose the most useful approaches to study it.

Poisonous milk and sinful mothers: the changing meaning of breastfeeding in the wake of the HIV epidemic in Addis Ababa, Ethiopia

BackgroundBreastfeeding remains normative and vital for child survival in the developing world. However, knowledge of the risk of Human Immunodeficiency Virus (HIV) transmission through breastfeeding has brought to attention the controversy of whether breastfeeding can be safely practiced by HIV positive mothers. Prevention of mother to child transmission (PMTCT) programs provide prevention services to HIV positive mothers including infant feeding counseling based on international guidelines. This study aimed at exploring infant feeding choices and how breastfeeding and the risk of HIV transmission through breastfeeding was interpreted among HIV positive mothers and their counselors in PMTCT programs in Addis Ababa, Ethiopia.MethodsThe study was conducted in the PMTCT clinics in two governmental hospitals in Addis Ababa, Ethiopia, using qualitative interviews and participant observation. Twenty two HIV positive mothers and ten health professionals working in PMTCT clinics were interviewed.ResultsThe study revealed that HIV positive mothers have developed an immense fear of breast milk which is out of proportion compared to the evidence of risk of transmission documented. The fear is expressed through avoidance of breastfeeding or, if no other choice is available, through an intense unease with the breastfeeding situation, and through expressions of sin, guilt, blame and regret. Health professionals working in the PMTCT programs seemed to largely share the fear of HIV positive mother's breast milk, and their anxiety was reflected in the counseling services they provided. Formula feeding was the preferred infant feeding method, and was chosen also by HIV positive women who had to beg in the streets for survival.ConclusionsThe fear of breast milk that seems to have developed among counselors and HIV positive mothers in the wake of the HIV epidemic may challenge a well established breastfeeding culture and calls for public health action. Based on strong evidence of the risks when infants are not exclusively breastfed, there is a great need to protect breastfeeding from pressures of replacement feeding and to promote exclusive breastfeeding as the best infant feeding option for HIV positive and HIV negative mothers alike.

Aleitamento materno e prevenção de infecções

Breast milk has a significant importance in the prevention of infections. It contains immunological components that make it unique and inimitable. Following birth, the gastrointestinal and immunologic systems of the newborn adapt to extrauterine life by undergoing a process of maturation and development. Breastfeeding should be fostered, protected and supported. Nonetheless there are rare and well-defined situations of maternal infections in which breastfeeding is counter-indicated. Such is the case of the human immunodeficiency virus (HIV) infection. The risk of the infant contracting HIV is increasing in populations with high prevalence of HIV lacking economic conditions, hygiene and medical support. When making the decision concerning breastfeeding, mothers should take into account both its benefits and the risks of disease transmission. The health care professional should inform, guide and support HIV positive mothers making the choice of infant feeding that is the most safe in their situation. The replacement of breast milk is recommended whenever acceptable, feasible, available, sustainable and safe. This is the most appropriate option given the fact that the baby's survival is high. The cytomegalovirus (CMV) is found in breast milk.The infection of the fetus or infant can occur through mothers with primary infection or in the course of reactivation. The vaccine of the hepatitis B virus (HBV) is very effective. In mothers with the hepatitis B surface antigen positive (HBs Ag), breastfeeding is not restricted.

Breastfeeding and the transmission of HIV

Mothers known to be human immunodeficiency virus (HIV) positive who choose to breastfeed their babies present a highly emotive debate. Portrayed by society as irresponsible and dangerous, HIV positive mothers face ignorance, social disapproval and exclusion. The choice to breastfeed is every mother's right and midwives play a fundamental role in supporting women's choices. This article aims to provide an evidence-based plan of action enabling the mother to reduce the risk of HIV transmission by breastfeeding, whether or not the HIV status of the infant is known. Research has shown antiretroviral therapy, exclusive breastfeeding, the prevention of mastitis and abrupt early weaning significantly reduce the risk of vertical transmission of HIV. Milk banks and home pasteurization of breast milk are potential alternatives for women with HIV who do not want to breastfeed but prefer their babies to enjoy the benefits of breast milk. Further research and financial input are necessary to make these possibilities a real choice for mothers with HIV.

PROPHYLACTIC MEASURES AGAINST INFECTION WITH HEPATITIS C VIRUS AND HIV IN INFANTS

Background. The World Health Organization estimates that every year more then 500,000 infants get infected with human immunodeficiency virus (HIV) and 10,000– 60,000 with hepatitis C virus (HCV) worldwide. Rapid and early diagnosis of HCV and HIV infection in exposed infants is rendered difficult because of transplacental passage of maternal IgG antibodies to the virus that are present in infants up to 18 months of age. Mother-to-infant transmission of HCV is comparatively uncommon. Furthermore, chronic hepatitis C does not appear to worsen the outcome of pregnancy or predispose fetal abnormalities. The rate of mother-to-infant transmission is 4 to 7% per pregnancy in women with HCV viremia. Perinatal infection with HCV is usually asymptomatic. Concomitant infection in pregnant women with HIV increases the rate of transmission of HCV infection 4 to 5 fold. Cesarean section is not recommended and current available medications against HCV infection are contraindicated because of fetal toxicity. Breast-feeding poses no relevant risk of HCV transmission. Conclusions. Perinatal transmission of HIV from mother to child accounts to 5 to 10% of acquired HIV infections worldwide. It is by far the major source of infection and represents more that 90% of all infections in children. Transmission of HIV occurs either before birth, during delivery or through breastfeeding. Recently, zidovudine and some other antiretrovirals administered during pregnancy, at delivery, and in the first 6 weeks of life to the infant have reduced transmission by more than two thirds (from 25 to less than 5%). The experts have also recommended elective cesarean section and dissuaded HIV positive mothers from breastfeeding. Experts must also test strategies to further decrease the risk for perinatal HCV and HIV infection. Significant progress in the area of new safe and effective vaccines is eagerly expected.

A Case of HIV (Human Immunodeficiency Virus) Infected Child Born to HIV Positive Mother

A case of HIV infected Indonesian baby girl born from an HIV positive mother is reported. This is the first HIV infected child reported in Indonesia. The diagnosis was based on the positive DNA HIV and HIV culture in the baby's blood taken at 3 days old. At this time the baby is still asymptomatic. Despite this we gave her prophylactic treatment against pneumocystis Carinii infection to prevent the possibility of pneumocystis Carinii pneumonia which is usually fatal under 1 year old. The positive HIV at 3 days old may indicative of intrauterine transmission. Because she is still asymptomatic, the intrauterine infection may be accured during late gestation. In spite of this we hope that the HIV infection in this baby is not a progressive one.

Antibody responses to Haemophilus influenzae type b and Streptococcus pneumoniae vaccines in children with human immunodeficiency virus infection

Antibody responses to Haemophilus influenzae type b (Hib) conjugate (ActHIB; Pasteur Merieux) and pneumococcal (Pneumovax II; Morson) vaccines were measured in 56 infected children (VI) and 44 uninfected children (U) older than 18 months of age, born to human immunodeficiency virus-positive mothers. Preimmunization, 21% U and 20% VI had protective concentrations of anti-Hib polysaccharide antibodies. Postimmunization, 100% U and 86% VI achieved protective titers (P = 0.008). The geometric mean increase in anti-Hib polysaccharide antibody was 7.6 (95% confidence interval, 3.5 to 16.3; P = 0.0001) times higher in U than in VI children after adjusting for age and ethnicity. Sixty-one percent U compared to 54% VI showed a 2-fold increase in antibody levels to at least one of the four pneumococcal vaccine serotypes (3, 6, 19, 23) measured (P = 0.4). For both vaccines there was a significant trend toward poorer responses in children with acquired immunodeficiency syndrome but no correlation with age adjusted CD4 counts. These data suggest that human immunodeficiency virus-infected children should be immunized with these polysaccharide vaccines early in the course of their disease.